<div id="content">
    <section class="main padder">
        <!-- booking table -->
        <div class="panel-body">
            <form id="main_form" class="form-horizontal parsley_form" method="post"  parsley-validate action="<?php echo $form_url; ?>" enctype="multipart/form-data">      
                <?php if ($this->session->flashdata('success_message') != ''): ?>
                    <div class="alert alert-success">
                        <button data-dismiss="alert" class="close" type="button"><i class="icon-remove"></i></button>
                        <i class="icon-ok-sign icon-large"></i> <?php echo $this->session->flashdata('success_message'); ?>
                    </div>
                <?php endif; ?>
                <?php if (is_admin() && !isset($is_frontend)): ?>
                    <div class="form-group">
                        <label class="col-lg-3 control-label">Application No</label>
                        <div class="col-lg-9 form-float">                        
                            <input type="text" name="application_no" placeholder="Application No" class="form-control"
                                   value="<?php echo isset($application_no) ? $application_no : ''; ?>">
                        </div>
                    </div>
                <?php endif; ?>
                <div class="page-header">
                    <h1 id="progress">Part I. Study Program <small>applicant may choose to apply to 1 or more programs</small></h1>
                </div>
                <h3>Please rank the Program in order to apply for  (1 being the most desirable, 3 the least)  </h3>
                <div class="form-group">
                    <label class="col-lg-5 control-label">Creative Digital Technology (CDT)</label>
                    <div class="col-lg-7 form-float">
                        <div class="radio">
                            <label class="radio-custom">
                                <input class="cdt_rank" type="radio" name="cdt_rank" value="1" <?php echo isset($cdt_rank) && $cdt_rank == '1' ? 'checked="checked"' : ''; ?>  <?php echo !isset($cdt_rank)? 'checked="checked"' : ''; ?>>
                                <i class="icon-circle-blank"></i>
                                1
                            </label>
                        </div>
                        <div class="radio">
                            <label class="radio-custom">
                                <input class="cdt_rank" type="radio" name="cdt_rank" value="2" <?php echo isset($cdt_rank) && $cdt_rank == '2' ? 'checked="checked"' : ''; ?>>
                                <i class="icon-circle-blank"></i>
                                2
                            </label>
                        </div>
                        <div class="radio">
                            <label class="radio-custom">
                                <input class="cdt_rank" type="radio" name="cdt_rank" value="3" <?php echo isset($cdt_rank) && $cdt_rank == '3' ? 'checked="checked"' : ''; ?>>
                                <i class="icon-circle-blank"></i>
                                3
                            </label>
                        </div>
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-lg-5 control-label">Innovative Digital Design (IDD)</label>
                    <div class="col-lg-7 form-float">
                        <div class="radio">
                            <label class="radio-custom">
                                <input class="did_rank" type="radio" name="did_rank" value="1" <?php echo isset($did_rank) && $did_rank == '1' ? 'checked="checked"' : ''; ?>>
                                <i class="icon-circle-blank"></i>
                                1
                            </label>
                        </div>
                        <div class="radio">
                            <label class="radio-custom">
                                <input class="did_rank" type="radio" name="did_rank" value="2" <?php echo isset($did_rank) && $did_rank == '2' ? 'checked="checked"' : ''; ?>  <?php echo !isset($did_rank)? 'checked="checked"' : ''; ?>>
                                <i class="icon-circle-blank"></i>
                                2
                            </label>
                        </div>
                        <div class="radio">
                            <label class="radio-custom">
                                <input class="did_rank" type="radio" name="did_rank" value="3" <?php echo isset($did_rank) && $did_rank == '3' ? 'checked="checked"' : ''; ?>>
                                <i class="icon-circle-blank"></i>
                                3
                            </label>
                        </div>                     
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-lg-5 control-label">Industrial Science and Management (ISc)</label>
                    <div class="col-lg-7 form-float">
                        <div class="radio">
                            <label class="radio-custom">
                                <input class="isc_rank" type="radio" name="isc_rank" value="1" <?php echo isset($isc_rank) && $isc_rank == '1' ? 'checked="checked"' : ''; ?>>
                                <i class="icon-circle-blank"></i>
                                1
                            </label>
                        </div>
                        <div class="radio">
                            <label class="radio-custom">
                                <input class="isc_rank" type="radio" name="isc_rank" value="2" <?php echo isset($isc_rank) && $isc_rank == '2' ? 'checked="checked"' : ''; ?>>
                                <i class="icon-circle-blank"></i>
                                2
                            </label>
                        </div>
                        <div class="radio">
                            <label class="radio-custom">
                                <input class="isc_rank" type="radio" name="isc_rank" value="3" <?php echo isset($isc_rank) && $isc_rank == '3' ? 'checked="checked"' : ''; ?>  <?php echo !isset($isc_rank)? 'checked="checked"' : ''; ?>>
                                <i class="icon-circle-blank"></i>
                                3
                            </label>
                        </div>                            
                    </div>
                </div>
                <div class="page-header">
                    <h1 id="progress">Part II. Personal Information</h1>
                </div>
                <div class="form-group">
                    <label class="col-lg-12">Applicant’s name  </label>
                    <label class="col-lg-3 control-label">In English</label>
                    <div class="col-lg-9">
                        <input id="name_en" type="text" name="name_en" placeholder="Applicant’s name In English" data-required="true" class="form-control"
                               value="<?php echo isset($name_en) ? $name_en : ''; ?>">
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-lg-3 control-label">In Thai</label>
                    <div class="col-lg-9">
                        <input id="name_th" type="text" name="name_th" placeholder="Applicant’s name In Thai" data-required="true" class="form-control"
                               value="<?php echo isset($name_th) ? $name_th : ''; ?>">
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-lg-3 control-label">Date of Birth (Day/Month/Year)</label>
                    <div class="col-lg-9">
                        <input id="birthday" type="text" class="combodate form-control" data-format="DD-MM-YYYY" data-template="D  MMM  YYYY" name="birthday" value="<?php echo isset($birthday) ? $birthday : ''; ?>">
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-lg-3 control-label">Nationality</label>
                    <div class="col-lg-9">
                        <input type="text" name="nationality" placeholder="Nationality" data-requiredxx="true" class="form-control small"
                               value="<?php echo isset($nationality) ? $nationality : ''; ?>">
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-lg-3 control-label">Gender</label>
                    <div class="col-lg-8 form-float">
                        <div class="radio">
                            <label class="radio-custom">
                                <input type="radio" name="gender" checked="checked" value="male" <?php echo isset($gender) && $gender == 'male' ? 'checked="checked"' : ''; ?>>
                                <i class="icon-circle-blank"></i>
                                Male
                            </label>                      
                        </div>
                        <div class="radio">
                            <label class="radio-custom">
                                <input type="radio" name="gender" value="female" <?php echo isset($gender) && $gender == 'female' ? 'checked="checked"' : ''; ?>>
                                <i class="icon-circle-blank"></i>
                                Female
                            </label>
                        </div>
                    </div>
                </div>  
                <div class="form-group">
                    <label class="col-lg-3 control-label">Religion</label>
                    <div class="col-lg-9">
                        <input type="text" name="religion" placeholder="Religion" data-requiredxx="true" class="form-control small"
                               value="<?php echo isset($religion) ? $religion : ''; ?>">
                    </div>
                </div>

                <div class="form-group">
                    <label class="col-lg-3 control-label">Citizenship</label>
                    <div class="col-lg-2">
                        <div class="radio">
                            <label class="radio-custom">
                                <input id="citizenship_th" type="radio" name="citizenship" value="thai" <?php echo isset($citizenship) && $citizenship == 'thai' ? 'checked="checked"' : ''; ?>>
                                <i class="icon-circle-blank"></i>
                                Thai
                            </label>                      
                        </div>
                    </div>
                    <div class="col-lg-7">
                        <label class=" control-label">Citizen ID Number</label>
                        <input id="citizen_id" type="text" name="citizen_id" placeholder="Citizen ID Number" data-requiredxx="true" class="form-control small"
                               value="<?php echo isset($citizen_id) ? $citizen_id : ''; ?>">
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-lg-3 control-label"></label>
                    <div class="col-lg-2">
                        <div class="radio">
                            <label class="radio-custom">
                                <input  id="citizenship_other" type="radio" name="citizenship" value="other" <?php echo isset($citizenship) && $citizenship == 'other' ? 'checked="checked"' : ''; ?>>
                                <i class="icon-circle-blank"></i>
                                Other
                            </label>                      
                        </div>
                    </div>
                    <div class="col-lg-3">
                        <label class=" control-label">Country of Citizenship</label>
                        <input id="citizenship_of" type="text" name="citizenship_of" placeholder="Country of Citizenship" data-requiredxx="true" class="form-control small"
                               value="<?php echo isset($citizenship_of) ? $citizenship_of : ''; ?>">
                    </div>
                    <div class="col-lg-4">
                        <label class=" control-label">Passport No.</label>
                        <input id="passport_no" type="text" name="passport_no" placeholder="Passport No." data-requiredxx="true" class="form-control small" 
                               value="<?php echo isset($passport_no) ? $passport_no : ''; ?>">
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-lg-3 control-label">Permanent address</label>
                    <div class="col-lg-9">
                        <textarea name="permanent_address" placeholder="Address" rows="5" class="form-control" data-trigger="keyup" data-rangelength="[20,200]" data-requiredxx="true"><?php echo isset($permanent_address) ? $permanent_address : ''; ?></textarea>                    
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-lg-3 control-label">Telephone</label>
                    <div class="col-lg-9">
                        <input type="text" name="telephone" placeholder="Telephone" parsley-type="phone" class="form-control small check_phone" 
                               value="<?php echo isset($telephone) ? $telephone : ''; ?>">
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-lg-3 control-label">Mobile phone</label>
                    <div class="col-lg-9">
                        <input type="text" name="mobilephone" placeholder="Mobile phone" data-requiredxx="true" class="form-control small  check_phone"
                               value="<?php echo isset($mobilephone) ? $mobilephone : ''; ?>">
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-lg-3 control-label">Mailing address <br/><small>(if different from above)</small></label>
                    <div class="col-lg-9">
                        <textarea name="mailing_address" placeholder="Address" rows="5" class="form-control" data-trigger="keyup" data-rangelength="[20,200]" data-requiredxx="true"><?php echo isset($mailing_address) ? $mailing_address : ''; ?></textarea>                    
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-lg-3 control-label">Telephone</label>
                    <div class="col-lg-9">
                        <input type="text" name="telephone2" placeholder="Telephone" data-requiredxx="true" class="form-control small  check_phone"
                               value="<?php echo isset($telephone2) ? $telephone2 : ''; ?>">
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-lg-3 control-label">E-mail address</label>
                    <div class="col-lg-9">
                        <input type="text" name="email" placeholder="E-mail" data-requiredxx="true" class="form-control small"
                               value="<?php echo isset($email) ? $email : ''; ?>">
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-lg-3 control-label">Father’s name</label>
                    <div class="col-lg-9">
                        <input type="text" name="father_name" placeholder="Father’s name" data-requiredxx="true" class="form-control"
                               value="<?php echo isset($father_name) ? $father_name : ''; ?>">
                    </div>
                </div>
                <div class="form-group">    
                    <div class="col-lg-3"></div>
                    <div class="col-lg-4">
                        <label class="control-label">Occupation</label>
                        <input type="text" name="father_occupation" placeholder="Occupation" data-requiredxx="true" class="form-control"
                               value="<?php echo isset($father_occupation) ? $father_occupation : ''; ?>">
                    </div>
                    <div class="col-lg-4">
                        <label class="control-label">Organization/Company</label>
                        <input type="text" name="father_company" placeholder="Organization/Company" data-requiredxx="true" class="form-control"
                               value="<?php echo isset($father_company) ? $father_company : ''; ?>">
                    </div>
                </div>
                <div class="form-group">    
                    <div class="col-lg-3"></div>
                    <div class="col-lg-4">
                        <label class="control-label">Telephone</label>
                        <input type="text" name="father_telephone" placeholder="Telephone" data-requiredxx="true" class="form-control  check_phone"
                               value="<?php echo isset($father_telephone) ? $father_telephone : ''; ?>">
                    </div>
                    <div class="col-lg-4">
                        <label class="control-label">E-mail address</label>
                        <input type="text" name="father_email" placeholder="E-mail address" data-requiredxx="true" class="form-control"
                               value="<?php echo isset($father_email) ? $father_email : ''; ?>">
                    </div>
                </div>

                <div class="form-group">
                    <label class="col-lg-3 control-label">Mother’s name</label>
                    <div class="col-lg-9">
                        <input type="text" name="mother_name" placeholder="Mother’s name" data-requiredxx="true" class="form-control"
                               value="<?php echo isset($mother_name) ? $mother_name : ''; ?>">
                    </div>
                </div>
                <div class="form-group">    
                    <div class="col-lg-3"></div>
                    <div class="col-lg-4">
                        <label class="control-label">Occupation</label>
                        <input type="text" name="mother_occupation" placeholder="Occupation" data-requiredxx="true" class="form-control"
                               value="<?php echo isset($mother_occupation) ? $mother_occupation : ''; ?>">
                    </div>
                    <div class="col-lg-4">
                        <label class="control-label">Organization/Company</label>
                        <input type="text" name="mother_company" placeholder="Organization/Company" data-requiredxx="true" class="form-control"
                               value="<?php echo isset($mother_company) ? $mother_company : ''; ?>">
                    </div>
                </div>
                <div class="form-group">    
                    <div class="col-lg-3"></div>
                    <div class="col-lg-4">
                        <label class="control-label">Telephone</label>
                        <input type="text" name="mother_telephone" placeholder="Telephone" data-requiredxx="true" class="form-control  check_phone"
                               value="<?php echo isset($mother_telephone) ? $mother_telephone : ''; ?>">
                    </div>
                    <div class="col-lg-4">
                        <label class="control-label">E-mail address</label>
                        <input type="text" name="mother_email" placeholder="E-mail address" data-requiredxx="true" class="form-control"
                               value="<?php echo isset($mother_email) ? $mother_email : ''; ?>">
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-lg-3 control-label">Guardian’s name <br/><small>(if not parents)</small></label>
                    <div class="col-lg-9">
                        <input type="text" name="guardian_name" placeholder="Guardian’s name" data-requiredxx="true" class="form-control"
                               value="<?php echo isset($guardian_name) ? $guardian_name : ''; ?>">
                    </div>
                </div>

                <div class="form-group">    
                    <div class="col-lg-3"></div>
                    <div class="col-lg-4">
                        <label class="control-label">Occupation</label>
                        <input type="text" name="guardian_occupation" placeholder="Occupation" data-requiredxx="true" class="form-control"
                               value="<?php echo isset($guardian_occupation) ? $guardian_occupation : ''; ?>">
                    </div>
                    <div class="col-lg-4">
                        <label class="control-label">Organization/Company</label>
                        <input type="text" name="guardian_company" placeholder="Organization/Company" data-requiredxx="true" class="form-control"
                               value="<?php echo isset($guardian_company) ? $guardian_company : ''; ?>">
                    </div>
                </div>
                <div class="form-group">    
                    <div class="col-lg-3"></div>
                    <div class="col-lg-4">
                        <label class="control-label">Telephone</label>
                        <input type="text" name="guardian_telephone" placeholder="Telephone" data-requiredxx="true" class="form-control  check_phone"
                               value="<?php echo isset($guardian_telephone) ? $guardian_telephone : ''; ?>">
                    </div>
                    <div class="col-lg-4">
                        <label class="control-label">E-mail address</label>
                        <input type="text" name="guardian_email" placeholder="E-mail address" data-requiredxx="true" class="form-control"
                               value="<?php echo isset($guardian_email) ? $guardian_email : ''; ?>">
                    </div>
                </div>

                <div class="page-header">
                    <h1 id="progress">Part III. Academic records</h1>
                </div>
                <div class="form-group">  
                    <h3 style="text-align: center;">Please provide full details of schools/colleges currently and previously attended (most recent first).</h3>
                </div>
                <div class="form-group">    
                    <div class="col-lg-2">
                        <label class="control-label" style="text-align: center; width: 100%;">Level<br/>(M6, IB IGCSE, <br/>etc.)</label>
                        <input type="text" name="academic_level_1" data-requiredxx="true" class="form-control" value="<?php echo isset($academic_level_1) ? $academic_level_1 : ''; ?>"><br/>
                        <input type="text" name="academic_level_2" data-requiredxx="true" class="form-control" value="<?php echo isset($academic_level_2) ? $academic_level_2 : ''; ?>"><br/>
                        <input type="text" name="academic_level_3" data-requiredxx="true" class="form-control" value="<?php echo isset($academic_level_3) ? $academic_level_3 : ''; ?>"><br/>
                    </div>
                    <div class="col-lg-1">
                        <label class="control-label" style="text-align: center; width: 100%;">Language <br/>of <br/>Instruction</label>
                        <input type="text" name="academic_language_1" data-requiredxx="true" class="form-control" value="<?php echo isset($academic_language_1) ? $academic_language_1 : ''; ?>"><br/>
                        <input type="text" name="academic_language_2" data-requiredxx="true" class="form-control" value="<?php echo isset($academic_language_2) ? $academic_language_2 : ''; ?>"><br/>
                        <input type="text" name="academic_language_3" data-requiredxx="true" class="form-control" value="<?php echo isset($academic_language_3) ? $academic_language_3 : ''; ?>"><br/>
                    </div>
                    <div class="col-lg-5">
                        <label class="control-label" style="text-align: center; width: 100%;">Institution<br/>(Name, City, and Country)<br/>&nbsp;</label>
                        <input type="text" name="academic_institution_1" data-requiredxx="true" class="form-control" value="<?php echo isset($academic_institution_1) ? $academic_institution_1 : ''; ?>"><br/>
                        <input type="text" name="academic_institution_2" data-requiredxx="true" class="form-control" value="<?php echo isset($academic_institution_2) ? $academic_institution_2 : ''; ?>"><br/>
                        <input type="text" name="academic_institution_3" data-requiredxx="true" class="form-control" value="<?php echo isset($academic_institution_3) ? $academic_institution_3 : ''; ?>"><br/>
                    </div>
                    <div class="col-lg-1">
                        <label class="control-label" style="text-align: center; width: 100%;">Major<br/>&nbsp;<br/>&nbsp;</label>
                        <input type="text" name="academic_major_1" data-requiredxx="true" class="form-control" value="<?php echo isset($academic_major_1) ? $academic_major_1 : ''; ?>"><br/>
                        <input type="text" name="academic_major_2" data-requiredxx="true" class="form-control" value="<?php echo isset($academic_major_2) ? $academic_major_2 : ''; ?>"><br/>
                        <input type="text" name="academic_major_3" data-requiredxx="true" class="form-control" value="<?php echo isset($academic_major_3) ? $academic_major_3 : ''; ?>"><br/>
                    </div>
                    <div class="col-lg-1">
                        <label class="control-label" style="text-align: center; width: 100%;">CGPA<br/>/GPX<br/>&nbsp;</label>
                        <input type="text" name="academic_gpa_1" data-requiredxx="true" class="form-control" value="<?php echo isset($academic_gpa_1) ? $academic_gpa_1 : ''; ?>"><br/>
                        <input type="text" name="academic_gpa_2" data-requiredxx="true" class="form-control" value="<?php echo isset($academic_gpa_2) ? $academic_gpa_2 : ''; ?>"><br/>
                        <input type="text" name="academic_gpa_3" data-requiredxx="true" class="form-control" value="<?php echo isset($academic_gpa_3) ? $academic_gpa_3 : ''; ?>"><br/>
                    </div>
                    <div class="col-lg-1">
                        <label class="control-label" style="text-align: center; width: 100%;">From<br/>(Month/Year)<br/>&nbsp;</label>
                        <input type="text" name="academic_from_1" data-requiredxx="true" class="form-control" value="<?php echo isset($academic_from_1) ? $academic_from_1 : ''; ?>"><br/>
                        <input type="text" name="academic_from_2" data-requiredxx="true" class="form-control" value="<?php echo isset($academic_from_2) ? $academic_from_2 : ''; ?>"><br/>
                        <input type="text" name="academic_from_3" data-requiredxx="true" class="form-control" value="<?php echo isset($academic_from_3) ? $academic_from_3 : ''; ?>"><br/>
                    </div>
                    <div class="col-lg-1">
                        <label class="control-label" style="text-align: center; width: 100%;">To<br/>(Month/Year)<br/>&nbsp;</label>
                        <input type="text" name="academic_to_1" data-requiredxx="true" class="form-control" value="<?php echo isset($academic_to_1) ? $academic_to_1 : ''; ?>"><br/>
                        <input type="text" name="academic_to_2" data-requiredxx="true" class="form-control" value="<?php echo isset($academic_to_2) ? $academic_to_2 : ''; ?>"><br/>
                        <input type="text" name="academic_to_3" data-requiredxx="true" class="form-control" value="<?php echo isset($academic_to_3) ? $academic_to_3 : ''; ?>"><br/>
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-lg-3 control-label">Awards, scholarships or prizes   <br/><small>(if any)</small></label>
                    <div class="col-lg-9">
                        <textarea name="awards" placeholder="Awards, scholarships or prizes" rows="2" class="form-control"><?php echo isset($awards) ? $awards : ''; ?></textarea>                    
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-lg-3 control-label">List any organization, community activities, or extracurricular activities</label>
                    <div class="col-lg-9">
                        <textarea name="activities" placeholder="List any organization, community activities, or extracurricular activities" rows="5" class="form-control"><?php echo isset($activities) ? $activities : ''; ?></textarea>                    
                    </div>
                </div>
                <div class="page-header">
                    <h1 id="progress">Part IV. Type of Admissions</h1>
                </div>
                <div class="form-group">
                    <h3 style="text-align: center;">Admission option: for students who submit Standardized Test Score.</h3>
                </div>
                <div class="form-group">
                    <label class="col-lg-3 control-label"></label>
                    <div class="col-lg-9">
                        <div class="checkbox">
                            <label class="checkbox-custom">
                                <input id="gpa_opt_1" type="checkbox" value="1" name="gpa_opt_1" <?php echo isset($gpa_opt_1) && $gpa_opt_1 == '1' ? 'checked="checked"' : ''; ?>>
                                <i class="icon-unchecked"></i>
                                I have an academic record of CGPA of 3.00 or 70%.
                            </label>
                        </div>
                        <label class="control-label">Indicate your CGPA/GPX</label>
                        <input id="gpa_opt_1_gpa" type="text" name="gpa_opt_1_gpa" placeholder="Indicate your CGPA/GPX" data-requiredxx="true" class="form-control small"
                               value="<?php echo isset($gpa_opt_1_gpa) ? $gpa_opt_1_gpa : ''; ?>">
                    </div>
                </div>

                <div class="form-group">
                    <label class="col-lg-3 control-label"></label>
                    <div class="col-lg-9">
                        <div class="checkbox">
                            <label class="checkbox-custom">
                                <input type="checkbox" value="1" id="is_promotion" name="gpa_opt_2" <?php echo isset($gpa_opt_2) && $gpa_opt_2 == '1' ? 'checked="checked"' : ''; ?>>
                                <i class="icon-unchecked"></i>
                                I have an academic record of CGPA of 2.70 to 2.99. 
                            </label>
                        </div>
                        <label class="control-label">Indicate your CGPA/GPX</label>
                        <input id="gpa_opt_2_gpa" type="text" name="gpa_opt_2_gpa" placeholder="Indicate your CGPA/GPX" data-requiredxx="true" class="form-control small"
                               value="<?php echo isset($gpa_opt_2_gpa) ? $gpa_opt_2_gpa : ''; ?>">
                        <label class="control-label">GPA in Mathematics</label>
                        <input id="gpa_opt_2_math" type="text" name="gpa_opt_2_math" placeholder="PA in Mathematics" data-requiredxx="true" class="form-control small"
                               value="<?php echo isset($gpa_opt_2_math) ? $gpa_opt_2_math : ''; ?>">
                        <label class="control-label">GPA in Physics</label>
                        <input id="gpa_opt_2_phy" type="text" name="gpa_opt_2_phy" placeholder="GPA in Physics" data-requiredxx="true" class="form-control small"
                               value="<?php echo isset($gpa_opt_2_phy) ? $gpa_opt_2_phy : ''; ?>">
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-lg-3 control-label"></label>
                    <div class="col-lg-9">
                        <div class="checkbox">
                            <label class="checkbox-custom">
                                <input type="checkbox" value="1" id="is_standard_test" name="is_standard_test" <?php echo isset($is_standard_test) && $is_standard_test == '1' ? 'checked="checked"' : ''; ?>>
                                <i class="icon-unchecked"></i>
                                I have a standardize test scores on the following subjects.
                            </label>
                        </div>
                    </div>
                </div>
                <div class="form-group" style="margin-bottom: 0px;">
                    <div class="col-lg-2 table_boxs">
                        <label class="control-label" style="text-align: center; width: 100%; height: 30px;">Standardized test score</label>
                    </div>
                    <div class="col-lg-3 table_boxs">
                        <label class="control-label" style="text-align: center; width: 100%; height: 30px;">Types of test taken</label>
                    </div>
                    <div class="col-lg-7 table_boxs table_boxs_l">
                        <label class="control-label" style="text-align: center; width: 100%; height: 30px;">Scores/Grades</label>
                    </div>
                </div>
                <div class="form-group" style="margin-bottom: 0px;">
                    <div class="col-lg-2 table_boxs" style="height: 300px;">
                        <h4 style="text-align: center;">English proficiency</h4>
                    </div>
                    <div class="col-lg-3 table_boxs" style="height: 300px;">
                        <div class="radio">
                            <label class="radio-custom"><input type="radio" name="english_test" value="TOEFL" <?php echo isset($english_test) && $english_test == 'TOEFL' ? 'checked="checked"' : ''; ?>>
                                <i class="icon-circle-blank"></i>TOEFL* 
                            </label>
                        </div>
                        <div class="radio">
                            <label class="radio-custom"><input type="radio" name="english_test" value="IELTS" <?php echo isset($english_test) && $english_test == 'IELTS' ? 'checked="checked"' : ''; ?>>
                                <i class="icon-circle-blank"></i>IELTS*    
                            </label>
                        </div>
                        <div class="radio">
                            <label class="radio-custom"><input type="radio" name="english_test" value="SAT" <?php echo isset($english_test) && $english_test == 'SAT' ? 'checked="checked"' : ''; ?>>
                                <i class="icon-circle-blank"></i>SAT <small>(Critical Reading)</small>
                            </label>
                        </div>
                        <div class="radio">
                            <label class="radio-custom"><input type="radio" name="english_test" value="TU-GET" <?php echo isset($english_test) && $english_test == 'TU-GET' ? 'checked="checked"' : ''; ?>>
                                <i class="icon-circle-blank"></i>TU-GET
                            </label>
                        </div>
                        <div class="radio">
                            <label class="radio-custom"><input type="radio" name="english_test" value="CU-TEP" <?php echo isset($english_test) && $english_test == 'CU-TEP' ? 'checked="checked"' : ''; ?>>
                                <i class="icon-circle-blank"></i>CU-TEP
                            </label>
                        </div>
                        <div class="radio">
                            <label class="radio-custom"><input type="radio" name="english_test" value="O-NET" <?php echo isset($english_test) && $english_test == 'O-NET' ? 'checked="checked"' : ''; ?>>
                                <i class="icon-circle-blank"></i>O-NET <small>(English)</small>
                            </label>
                        </div>                        
                    </div>
                    <div class="col-lg-7 table_boxs table_boxs_l" style="height: 300px;">
                        <div class="row">
                            <div class="form-float col-lg-12" style="height: 30px;">
                                <div class="radio">
                                    <label class="radio-custom">
                                        <input type="radio" name="english_test_base" checked="checked" value="Paper-based" <?php echo isset($english_test_base) && $english_test_base == 'Paper-based' ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-circle-blank"></i>
                                        Paper-based
                                    </label>                      
                                </div>
                                <div class="radio">
                                    <label class="radio-custom">
                                        <input type="radio" name="english_test_base" value="Computer-based" <?php echo isset($english_test_base) && $english_test_base == 'Computer-based' ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-circle-blank"></i>
                                        Computer-based
                                    </label>
                                </div>
                                <div class="radio">
                                    <label class="radio-custom">
                                        <input type="radio" name="english_test_base" value="Internet-based" <?php echo isset($english_test_base) && $english_test_base == 'Internet-based' ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-circle-blank"></i>
                                        Internet-based
                                    </label>
                                </div>

                            </div>
                            <div class="col-lg-12">
                                <label class="control-label">Overall</label>
                                <input class="form-control small parsley-validated" type="text" data-requiredxx="true" placeholder="Overall"
                                       name="english_test_overall" value="<?php echo isset($english_test_overall) ? $english_test_overall : ''; ?>">
                            </div>
                            <div  class="col-lg-5 col-md-offset-1">
                                <label class="control-label">Writing</label>
                                <input class="form-control small parsley-validated" type="text" data-requiredxx="true" placeholder="Writing" 
                                       name="english_test_writing" value="<?php echo isset($english_test_writing) ? $english_test_writing : ''; ?>">
                            </div>
                            <div  class="col-lg-6">
                                <label class="control-label">Reading</label>
                                <input class="form-control small parsley-validated" type="text" data-requiredxx="true" placeholder="Reading" 
                                       name="english_test_reading"  value="<?php echo isset($english_test_reading) ? $english_test_reading : ''; ?>">
                            </div>
                            <div  class="col-lg-5 col-md-offset-1">
                                <label class="control-label">Speaking</label>
                                <input class="form-control small parsley-validated" type="text" data-requiredxx="true" placeholder="Speaking" 
                                       name="english_test_speaking"  value="<?php echo isset($english_test_speaking) ? $english_test_speaking : ''; ?>">
                            </div>
                            <div  class="col-lg-6">
                                <label class="control-label">Listening</label>
                                <input class="form-control small parsley-validated" type="text" data-requiredxx="true" placeholder="Listening" 
                                       name="english_test_listening"  value="<?php echo isset($english_test_listening) ? $english_test_listening : ''; ?>">
                            </div>
                            <div class="col-lg-12 clear">
                                <label class="control-label">Date Taken</label><br>
                                <input id="english_test_date" type="text" class="combodate form-control" data-format="DD-MM-YYYY" data-template="D  MMM  YYYY" name="english_test_date" value="<?php echo isset($english_test_date) ? $english_test_date : ''; ?>">                                
                            </div>

                        </div>
                    </div>
                </div>
                <div class="form-group" style="margin-bottom: 0px;">
                    <div class="col-lg-2 table_boxs" style="height: 170px;">
                        <h4 style="text-align: center;">Sciences</h4>
                    </div>
                    <div class="col-lg-3  table_boxs" style="height: 170px;">
                        <div class="row">
                            <div class="col-lg-6">
                                <div class="radio">
                                    <label class="radio-custom"><input type="radio" name="science_test" value="SAT" <?php echo isset($science_test) && $science_test == 'SAT' ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-circle-blank"></i>SAT
                                    </label>
                                </div>
                                <div class="radio">
                                    <label class="radio-custom"><input type="radio" name="science_test" value="GCE_O" <?php echo isset($science_test) && $science_test == 'GCE_O' ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-circle-blank"></i>GCE’ O level   
                                    </label>
                                </div>
                                <div class="radio">
                                    <label class="radio-custom"><input type="radio" name="science_test" value="GCE_A" <?php echo isset($science_test) && $science_test == 'GCE_A' ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-circle-blank"></i>GCE’ A level 
                                    </label>
                                </div>
                                <div class="radio">
                                    <label class="radio-custom"><input type="radio" name="science_test" value="GED" <?php echo isset($science_test) && $science_test == 'GED' ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-circle-blank"></i>GED
                                    </label>
                                </div>
                                <div class="radio">
                                    <label class="radio-custom"><input type="radio" name="science_test" value="AP" <?php echo isset($science_test) && $science_test == 'AP' ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-circle-blank"></i>AP
                                    </label>
                                </div>                        
                            </div>
                            <div class="col-lg-6">
                                <div class="radio">
                                    <label class="radio-custom"><input type="radio" name="science_test" value="SAT_II" <?php echo isset($science_test) && $science_test == 'SAT_II' ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-circle-blank"></i>SAT II 
                                    </label>
                                </div>
                                <div class="radio">
                                    <label class="radio-custom"><input type="radio" name="science_test" value="GCSE" <?php echo isset($science_test) && $science_test == 'GCSE' ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-circle-blank"></i>GCSE  
                                    </label>
                                </div>
                                <div class="radio">
                                    <label class="radio-custom"><input type="radio" name="science_test" value="IGCSE" <?php echo isset($science_test) && $science_test == 'IGCSE' ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-circle-blank"></i>IGCSE
                                    </label>
                                </div>
                                <div class="radio">
                                    <label class="radio-custom"><input type="radio" name="science_test" value="IB" <?php echo isset($science_test) && $science_test == 'IB' ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-circle-blank"></i>IB
                                    </label>
                                </div>     
                                <div class="radio">
                                    <label class="radio-custom"><input type="radio" name="science_test" value="ACT" <?php echo isset($science_test) && $science_test == 'ACT' ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-circle-blank"></i>ACT
                                    </label>
                                </div>     
                            </div>
                        </div>
                    </div>

                    <div class="col-lg-7 table_boxs table_boxs_l" style="height: 170px;">
                        <div class="row">
                            <div  class="col-lg-2 col-md-offset-1">
                                <label class="control-label" style="text-align: center; width: 100%;">Overall<br/>&nbsp;</label>
                                <input class="form-control parsley-validated" type="text" data-requiredxx="true" placeholder="Overall" style="width: 100%;"
                                       name="science_test_overall"  value="<?php echo isset($science_test_overall) ? $science_test_overall : ''; ?>">
                            </div>
                            <div  class="col-lg-2">
                                <label class="control-label" style="text-align: center; width: 100%;">Math/<br/>Calculus AB</label>
                                <input class="form-control parsley-validated" type="text" data-requiredxx="true" placeholder="Math/Calculus AB" style="width: 100%;"
                                       name="science_test_math"  value="<?php echo isset($science_test_math) ? $science_test_math : ''; ?>">
                            </div>
                            <div  class="col-lg-2">
                                <label class="control-label" style="text-align: center; width: 100%;">Physics/<br/>Physics B</label>
                                <input class="form-control parsley-validated" type="text" data-requiredxx="true" placeholder="Physics/Physics B" style="width: 100%;"
                                       name="science_test_phy"  value="<?php echo isset($science_test_phy) ? $science_test_phy : ''; ?>">
                            </div>
                            <div  class="col-lg-2">
                                <label class="control-label" style="text-align: center; width: 100%;">Chemistry<br/>&nbsp;</label>
                                <input class="form-control parsley-validated" type="text" data-requiredxx="true" placeholder="Chemistry" style="width: 100%;"
                                       name="science_test_chem"  value="<?php echo isset($science_test_chem) ? $science_test_chem : ''; ?>">
                            </div>
                            <div  class="col-lg-2">
                                <label class="control-label" style="text-align: center; width: 100%;">Biology<br/>&nbsp;</label>
                                <input class="form-control parsley-validated" type="text" data-requiredxx="true" placeholder="Biology" style="width: 100%;"
                                       name="science_test_bio"  value="<?php echo isset($science_test_bio) ? $science_test_bio : ''; ?>">
                            </div>
                            <div class="col-lg-12 clear">
                                <label class="control-label">Date Taken</label><br>
                                <input id="science_test_date" type="text" class="combodate form-control" data-format="DD-MM-YYYY" data-template="D  MMM  YYYY" name="science_test_date" value="<?php echo isset($science_test_date) ? $science_test_date : ''; ?>">                                
                            </div>
                        </div>
                    </div>
                </div>
                <div class="form-group" style="margin-bottom: 0px;">
                    <div class="col-lg-2 table_boxs table_boxs_b" style="height: 170px;">
                        <h4 style="text-align: center;">Thai National Admission</h4>
                    </div>
                    <div class="col-lg-3 table_boxs table_boxs_b" style="height: 170px;">
                        <?php
                        if (isset($admission_test)) {
                            $admission_selected = explode('|', $admission_test);
                        }
                        ?>
                        <div class="checkbox">
                            <label class="checkbox-custom"><input type="checkbox" name="admission_test[]" value="O-NET" <?php echo isset($admission_test) && in_array('O-NET', $admission_selected) ? 'checked="checked"' : ''; ?>>
                                <i class="icon-unchecked"></i>O-NET
                            </label>
                        </div>
                        <div class="checkbox">
                            <label class="checkbox-custom"><input type="checkbox" name="admission_test[]" value="A-NET" <?php echo isset($admission_test) && in_array('A-NET', $admission_selected) ? 'checked="checked"' : ''; ?>>
                                <i class="icon-unchecked"></i>A-NET   
                            </label>
                        </div>
                        <div class="checkbox">
                            <label class="checkbox-custom"><input type="checkbox" name="admission_test[]" value="GAT" <?php echo isset($admission_test) && in_array('GAT', $admission_selected) ? 'checked="checked"' : ''; ?>>
                                <i class="icon-unchecked"></i>GAT
                            </label>
                        </div>
                        <div class="checkbox">
                            <label class="checkbox-custom"><input type="checkbox" name="admission_test[]" value="PAT 1" <?php echo isset($admission_test) && in_array('PAT 1', $admission_selected) ? 'checked="checked"' : ''; ?>>
                                <i class="icon-unchecked"></i>PAT 1
                            </label>
                        </div>
                        <div class="checkbox">
                            <label class="checkbox-custom"><input type="checkbox" name="admission_test[]" value="PAT 2" <?php echo isset($admission_test) && in_array('PAT 2', $admission_selected) ? 'checked="checked"' : ''; ?>>
                                <i class="icon-unchecked"></i>PAT 2
                            </label>
                        </div>                     
                    </div>
                    <div class="col-lg-7 table_boxs table_boxs_l table_boxs_b" style="height: 170px;">
                        <div class="row">
                            <div  class="col-lg-2 col-md-offset-1">
                                <label class="control-label" style="text-align: center; width: 100%;">O-NET<br/>&nbsp;</label>
                                <input class="form-control parsley-validated" type="text" data-requiredxx="true" placeholder="O-NET" name="admission_test_onet" style="width: 100%;"
                                       value="<?php echo isset($admission_test_onet) ? $admission_test_onet : ''; ?>">
                                <label class="control-label" style="text-align: center; width: 100%;">Date</label>
                                <input class="form-control datepicker" type="text" data-date-format="dd-mm-yyyy" style="width: 100%;"
                                       name="admission_test_onet_date" value="<?php echo isset($admission_test_onet_date) ? $admission_test_onet_date : ''; ?>">
                            </div>
                            <div  class="col-lg-2">
                                <label class="control-label" style="text-align: center; width: 100%;">A-NET<br/>Sciences</label>
                                <input class="form-control parsley-validated" type="text" data-requiredxx="true" placeholder="A-NET" name="admission_test_anet" style="width: 100%;"
                                       value="<?php echo isset($admission_test_anet) ? $admission_test_anet : ''; ?>">
                                <label class="control-label" style="text-align: center; width: 100%;">Date</label>
                                <input class="form-control datepicker" type="text" data-date-format="dd-mm-yyyy" style="width: 100%;"
                                       name="admission_test_anet_date" value="<?php echo isset($admission_test_anet_date) ? $admission_test_anet_date : ''; ?>">
                            </div>
                            <div  class="col-lg-2">
                                <label class="control-label" style="text-align: center; width: 100%;">GAT<br/>&nbsp;</label>
                                <input class="form-control parsley-validated" type="text" data-requiredxx="true" placeholder="GAT" name="admission_test_gat" style="width: 100%;"
                                       value="<?php echo isset($admission_test_gat) ? $admission_test_gat : ''; ?>">
                                <label class="control-label" style="text-align: center; width: 100%;">Date</label>
                                <input class="form-control datepicker" type="text" data-date-format="dd-mm-yyyy" style="width: 100%;"
                                       name="admission_test_gat_date" value="<?php echo isset($admission_test_gat_date) ? $admission_test_gat_date : ''; ?>">
                            </div>
                            <div  class="col-lg-2">
                                <label class="control-label" style="text-align: center; width: 100%;">PAT 1<br/>Math</label>
                                <input class="form-control parsley-validated" type="text" data-requiredxx="true" placeholder="PAT 1" name="admission_test_pati" style="width: 100%;"
                                       value="<?php echo isset($admission_test_pati) ? $admission_test_pati : ''; ?>">
                                <label class="control-label" style="text-align: center; width: 100%;">Date</label>
                                <input class="form-control datepicker" type="text" data-date-format="dd-mm-yyyy" style="width: 100%;"
                                       name="admission_test_pati_date" value="<?php echo isset($admission_test_pati_date) ? $admission_test_pati_date : ''; ?>">
                            </div>
                            <div  class="col-lg-2">
                                <label class="control-label" style="text-align: center; width: 100%;">PAT 2<br/>Sciences</label>
                                <input class="form-control parsley-validated" type="text" data-requiredxx="true" placeholder="PAT 2" name="admission_test_patii" style="width: 100%;"
                                       value="<?php echo isset($admission_test_patii) ? $admission_test_patii : ''; ?>">
                                <label class="control-label" style="text-align: center; width: 100%;">Date</label>
                                <input class="form-control datepicker" type="text" data-date-format="dd-mm-yyyy" style="width: 100%;"
                                       name="admission_test_patii_date" value="<?php echo isset($admission_test_patii_date) ? $admission_test_patii_date : ''; ?>">
                            </div>
                        </div>
                    </div>
                </div>
                <div class="form-group">
                    <h4>* Remark : English standard test score, if qualified, can be submitted for exception from EL 171 English Course II and EL 172 English Course III.</h4>
                </div>
                <div class="page-header">
                    <h1 id="progress">Part V. Additional Information <small>(This part does not affect your application result)</small></h1>
                </div>
                <div class="form-group">
                    <label class="col-lg-12">From which source did you learn about Science Programs at Thammasat University?</label>
                </div>
                <div class="row form-group">
                    <?php
                    if (isset($sources)) {
                        $sources_selected = explode('|', $sources);
                    }
                    ?>
                    <div class="col-lg-3">
                        <div class="checkbox">
                            <label class="checkbox-custom">
                                <input type="checkbox" name="sources[]" value="1" <?php echo isset($sources) && in_array('1', $sources_selected) ? 'checked="checked"' : ''; ?>>
                                <i class="icon-unchecked"></i>Our visit to your school
                            </label>                     
                        </div>
                    </div>
                    <div class="col-lg-3">
                        <div class="checkbox">
                            <label class="checkbox-custom">
                                <input type="checkbox" name="sources[]" value="2" <?php echo isset($sources) && in_array('2', $sources_selected) ? 'checked="checked"' : ''; ?>>
                                <i class="icon-unchecked"></i>Newspaper or magazine <small>(please specify)</small>
                            </label>                     
                        </div>
                    </div>
                    <div class="col-lg-6">
                        <input class="form-control parsley-validated" type="text" data-requiredxx="true" placeholder="Newspaper or magazine" name="sources_specify_1" style="width: 100%;"
                               value="<?php echo isset($sources_specify_1) ? $sources_specify_1 : ''; ?>">
                    </div>
                    <div class="col-lg-3">
                        <div class="checkbox">
                            <label class="checkbox-custom">
                                <input type="checkbox" name="sources[]" value="3" <?php echo isset($sources) && in_array('3', $sources_selected) ? 'checked="checked"' : ''; ?>>
                                <i class="icon-unchecked"></i>Parents or relatives
                            </label>                     
                        </div>
                    </div>
                    <div class="col-lg-3">
                        <div class="checkbox">
                            <label class="checkbox-custom">
                                <input type="checkbox" name="sources[]" value="4" <?php echo isset($sources) && in_array('4', $sources_selected) ? 'checked="checked"' : ''; ?>>
                                <i class="icon-unchecked"></i>Exhibition <small>(please specify)</small>
                            </label>                     
                        </div>
                    </div>
                    <div class="col-lg-6">
                        <input class="form-control parsley-validated" type="text" data-requiredxx="true" placeholder="Exhibition" name="sources_specify_2" style="width: 100%;"
                               value="<?php echo isset($sources_specify_2) ? $sources_specify_2 : ''; ?>">
                    </div>
                    <div class="col-lg-3">
                        <div class="checkbox">
                            <label class="checkbox-custom">
                                <input type="checkbox" name="sources[]" value="5" <?php echo isset($sources) && in_array('5', $sources_selected) ? 'checked="checked"' : ''; ?>>
                                <i class="icon-unchecked"></i>Friends
                            </label>                     
                        </div>
                    </div>
                    <div class="col-lg-3">
                        <div class="checkbox">
                            <label class="checkbox-custom">
                                <input type="checkbox" name="sources[]" value="6" <?php echo isset($sources) && in_array('6', $sources_selected) ? 'checked="checked"' : ''; ?>>
                                <i class="icon-unchecked"></i>Website <small>(please specify)</small>
                            </label>                     
                        </div>
                    </div>
                    <div class="col-lg-6">
                        <input class="form-control parsley-validated" type="text" data-requiredxx="true" placeholder="Website" name="sources_specify_3" style="width: 100%;"
                               value="<?php echo isset($sources_specify_3) ? $sources_specify_3 : ''; ?>">
                    </div>
                    <div class="col-lg-3">
                        <div class="checkbox">
                            <label class="checkbox-custom">
                                <input type="checkbox" name="sources[]" value="7" <?php echo isset($sources) && in_array('7', $sources_selected) ? 'checked="checked"' : ''; ?>>
                                <i class="icon-unchecked"></i>Our students
                            </label>                     
                        </div>
                    </div>
                    <div class="col-lg-3">
                        <div class="checkbox">
                            <label class="checkbox-custom">
                                <input type="checkbox" name="sources[]" value="8" <?php echo isset($sources) && in_array('8', $sources_selected) ? 'checked="checked"' : ''; ?>>
                                <i class="icon-unchecked"></i>TV or radio advertisement <small>(please specify)</small>
                            </label>                     
                        </div>
                    </div>
                    <div class="col-lg-6">
                        <input class="form-control parsley-validated" type="text" data-requiredxx="true" placeholder="TV or radio advertisement" name="sources_specify_4" style="width: 100%;"
                               value="<?php echo isset($sources_specify_4) ? $sources_specify_4 : ''; ?>">
                    </div>
                    <div class="col-lg-3">
                        <div class="checkbox">
                            <label class="checkbox-custom">
                                <input type="checkbox" name="sources[]" value="9" <?php echo isset($sources) && in_array('9', $sources_selected) ? 'checked="checked"' : ''; ?>>
                                <i class="icon-unchecked"></i>Our alumni
                            </label>                     
                        </div>
                    </div>
                    <div class="col-lg-3">
                        <div class="checkbox">
                            <label class="checkbox-custom">
                                <input type="checkbox" name="sources[]" value="10" <?php echo isset($sources) && in_array('10', $sources_selected) ? 'checked="checked"' : ''; ?>>
                                <i class="icon-unchecked"></i>Other sources <small>(please specify)</small>
                            </label>                     
                        </div>
                    </div>
                    <div class="col-lg-6">
                        <input class="form-control parsley-validated" type="text" data-requiredxx="true" placeholder="Other sources" name="sources_specify_5" style="width: 100%;"
                               value="<?php echo isset($sources_specify_5) ? $sources_specify_5 : ''; ?>">
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-lg-12">Please list names of other school/ university that you are applying or plan to apply to</label>
                </div>
                <div class="row form-group">
                    <label class="col-lg-1 control-label">1)</label>
                    <div class="col-lg-5">
                        <input class=" form-control parsley-validated" type="text" data-requiredxx="true" placeholder="school/university" name="another_school_1" style="width: 100%;"
                               value="<?php echo isset($another_school_1) ? $another_school_1 : ''; ?>">
                    </div>
                    <label class="col-lg-1 control-label">2)</label>
                    <div class="col-lg-5">
                        <input class=" form-control parsley-validated" type="text" data-requiredxx="true" placeholder="school/university" name="another_school_2" style="width: 100%;"
                               value="<?php echo isset($another_school_2) ? $another_school_2 : ''; ?>">
                    </div>
                    <label class="col-lg-1 control-label">3)</label>
                    <div class="col-lg-5">
                        <input class=" form-control parsley-validated" type="text" data-requiredxx="true" placeholder="school/university" name="another_school_3" style="width: 100%;"
                               value="<?php echo isset($another_school_3) ? $another_school_3 : ''; ?>">
                    </div>
                    <label class="col-lg-1 control-label">4)</label>
                    <div class="col-lg-5">
                        <input class=" form-control parsley-validated" type="text" data-requiredxx="true" placeholder="school/university" name="another_school_4" style="width: 100%;"
                               value="<?php echo isset($another_school_4) ? $another_school_4 : ''; ?>">
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-lg-12">How would you like this program to improve in order to serve you better? Your suggestions are welcome</label>
                    <div class="col-lg-12">
                        <input class="form-control parsley-validated" type="text" data-requiredxx="true" placeholder="" name="suggestions" style="width: 100%;"
                               value="<?php echo isset($suggestions) ? $suggestions : ''; ?>">
                    </div>
                </div>

                <div class="page-header">
                    <h1 id="progress">Part VI. Documentation and application fee</h1>
                </div>
                <h3 style="text-align: center;">Please enclose required and supporting documents and the application fee with this application.</h3>
                <div class="form-group">
                    <div class="col-lg-5">
                        <strong>Required documents</strong><br>
                        Mark the box(s) indicating the material you enclosed. 
                    </div>
                    <div class="col-lg-1 box-color">
                        <label class="center"><small>Boxes for official use only</small></label>
                    </div>
                    <div class="col-lg-5">
                        <strong>Required documents</strong><br>
                        Mark the box(s) indicating the material you enclosed. 
                    </div>
                    <div class="col-lg-1 box-color">
                        <label class="center"><small>Boxes for official use only</small></label>
                    </div>
                    <div class="col-lg-5"  style="height: 355px;">
                        <?php
                        if (isset($required_doc)) {
                            $required_doc_selected = explode('|', $required_doc);
                        }

                        if (isset($required_doc_staff)) {
                            $required_doc_staff_selected = explode('|', $required_doc_staff);
                        }
                        ?>
                        <div class="checkbox">
                            <label class="checkbox-custom">
                                <input type="checkbox" name="required_doc[]" value="1" <?php echo isset($required_doc) && in_array('1', $required_doc_selected) ? 'checked="checked"' : ''; ?>>
                                <i class="icon-unchecked"></i>3 recent 1-inch photographs
                            </label>                     
                        </div>
                        <div class="checkbox">
                            <label class="checkbox-custom">
                                <input type="checkbox" name="required_doc[]" value="2" <?php echo isset($required_doc) && in_array('2', $required_doc_selected) ? 'checked="checked"' : ''; ?>>
                                <i class="icon-unchecked"></i>A photocopy of the applicant’s citizen ID /or A photocopy of passport for foreign applicant
                            </label>                     
                        </div>
                        <div class="checkbox">
                            <label class="checkbox-custom">
                                <input type="checkbox" name="required_doc[]" value="3" <?php echo isset($required_doc) && in_array('3', $required_doc_selected) ? 'checked="checked"' : ''; ?>>
                                <i class="icon-unchecked"></i>A photocopy of transcript of academic record from high school attended /or A photocopy of certificate or diploma earned
                            </label>                     
                        </div>
                        <div class="checkbox">
                            <label class="checkbox-custom">
                                <input type="checkbox" name="required_doc[]" value="4" <?php echo isset($required_doc) && in_array('4', $required_doc_selected) ? 'checked="checked"' : ''; ?>>
                                <i class="icon-unchecked"></i>A photocopy of house registration (for Thai only)
                            </label>                     
                        </div>
                        <div class="checkbox">
                            <label class="checkbox-custom">
                                <input type="checkbox" name="required_doc[]" value="5" <?php echo isset($required_doc) && in_array('5', $required_doc_selected) ? 'checked="checked"' : ''; ?>>
                                <i class="icon-unchecked"></i>A certificate of equivalence issued by the Ministry of Education, Thailand. 
                                (Required for applicants graduating from international school.)

                            </label>                     
                        </div>
                    </div>
                    <div class="col-lg-1 box-color"  style="height: 355px;">
                        <div class="checkbox center" style="padding-left: 0px;">
                            <label class="checkbox-custom">
                                <input type="checkbox" name="required_doc_staff[]" value="1" <?php echo isset($required_doc_staff) && in_array('1', $required_doc_staff_selected) ? 'checked="checked"' : ''; ?> <?php echo is_loggedin() ? 'disabled="disabled"' : ''; ?>>
                                <i class="icon-unchecked"></i>
                            </label>                     
                        </div>
                        <div class="checkbox center" style="padding-left: 0px;">
                            <label class="checkbox-custom">
                                <input type="checkbox" name="required_doc_staff[]" value="2" <?php echo isset($required_doc_staff) && in_array('2', $required_doc_staff_selected) ? 'checked="checked"' : ''; ?> <?php echo is_loggedin() ? 'disabled="disabled"' : ''; ?>>
                                <i class="icon-unchecked"></i><br/>&nbsp;
                            </label>                     
                        </div>
                        <div class="checkbox center" style="padding-left: 0px;">
                            <label class="checkbox-custom">
                                <input type="checkbox" name="required_doc_staff[]" value="3" <?php echo isset($required_doc_staff) && in_array('3', $required_doc_staff_selected) ? 'checked="checked"' : ''; ?> <?php echo is_loggedin() ? 'disabled="disabled"' : ''; ?>>
                                <i class="icon-unchecked"></i><br/>&nbsp;
                            </label>                     
                        </div>
                        <div class="checkbox center" style="padding-left: 0px;">
                            <label class="checkbox-custom">
                                <input type="checkbox" name="required_doc_staff[]" value="4" <?php echo isset($required_doc_staff) && in_array('4', $required_doc_staff_selected) ? 'checked="checked"' : ''; ?> <?php echo is_loggedin() ? 'disabled="disabled"' : ''; ?>>
                                <i class="icon-unchecked"></i>
                            </label>                     
                        </div>
                        <div class="checkbox center" style="padding-left: 0px;">
                            <label class="checkbox-custom">
                                <input type="checkbox" name="required_doc_staff[]" value="5" <?php echo isset($required_doc_staff) && in_array('5', $required_doc_staff_selected) ? 'checked="checked"' : ''; ?> <?php echo is_loggedin() ? 'disabled="disabled"' : ''; ?>>
                                <i class="icon-unchecked"></i>
                            </label>                     
                        </div>
                    </div>
                    <div class="col-lg-5" style="height: 355px;">
                        <strong>Original score report of Standardized Test Scores</strong>
                        <div class="row">

                            <div class="col-lg-6">
                                <div class="checkbox">
                                    <label class="checkbox-custom">
                                        <input type="checkbox" name="required_doc[]" value="6" <?php echo isset($required_doc) && in_array('6', $required_doc_selected) ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-unchecked"></i>SAT
                                    </label>                     
                                </div>
                                <div class="checkbox">
                                    <label class="checkbox-custom">
                                        <input type="checkbox" name="required_doc[]" value="7" <?php echo isset($required_doc) && in_array('7', $required_doc_selected) ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-unchecked"></i>GCE’ O level
                                    </label>                     
                                </div>
                                <div class="checkbox">
                                    <label class="checkbox-custom">
                                        <input type="checkbox" name="required_doc[]" value="8" <?php echo isset($required_doc) && in_array('8', $required_doc_selected) ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-unchecked"></i>GCE’ A level 
                                    </label>                     
                                </div>
                                <div class="checkbox">
                                    <label class="checkbox-custom">
                                        <input type="checkbox" name="required_doc[]" value="9" <?php echo isset($required_doc) && in_array('9', $required_doc_selected) ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-unchecked"></i>GED
                                    </label>                     
                                </div>
                                <div class="checkbox">
                                    <label class="checkbox-custom">
                                        <input type="checkbox" name="required_doc[]" value="10" <?php echo isset($required_doc) && in_array('10', $required_doc_selected) ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-unchecked"></i>AP
                                    </label>                     
                                </div>
                                <div class="checkbox">
                                    <label class="checkbox-custom">
                                        <input type="checkbox" name="required_doc[]" value="11" <?php echo isset($required_doc) && in_array('11', $required_doc_selected) ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-unchecked"></i>O-NET
                                    </label>                     
                                </div>
                                <div class="checkbox">
                                    <label class="checkbox-custom">
                                        <input type="checkbox" name="required_doc[]" value="12" <?php echo isset($required_doc) && in_array('12', $required_doc_selected) ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-unchecked"></i>PAT-1
                                    </label>                     
                                </div>
                                <div class="checkbox">
                                    <label class="checkbox-custom">
                                        <input type="checkbox" name="required_doc[]" value="13" <?php echo isset($required_doc) && in_array('13', $required_doc_selected) ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-unchecked"></i>PAT-2
                                    </label>                     
                                </div>
                            </div>
                            <div class="col-lg-6">
                                <div class="checkbox">
                                    <label class="checkbox-custom">
                                        <input type="checkbox" name="required_doc[]" value="14" <?php echo isset($required_doc) && in_array('14', $required_doc_selected) ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-unchecked"></i>SAT II 
                                    </label>                     
                                </div>
                                <div class="checkbox">
                                    <label class="checkbox-custom">
                                        <input type="checkbox" name="required_doc[]" value="15" <?php echo isset($required_doc) && in_array('15', $required_doc_selected) ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-unchecked"></i>GCSE
                                    </label>                     
                                </div>
                                <div class="checkbox">
                                    <label class="checkbox-custom">
                                        <input type="checkbox" name="required_doc[]" value="16" <?php echo isset($required_doc) && in_array('16', $required_doc_selected) ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-unchecked"></i>IGCSE 
                                    </label>                     
                                </div>
                                <div class="checkbox">
                                    <label class="checkbox-custom">
                                        <input type="checkbox" name="required_doc[]" value="17" <?php echo isset($required_doc) && in_array('17', $required_doc_selected) ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-unchecked"></i>IB
                                    </label>                     
                                </div>
                                <div class="checkbox">
                                    <label class="checkbox-custom">
                                        <input type="checkbox" name="required_doc[]" value="18" <?php echo isset($required_doc) && in_array('18', $required_doc_selected) ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-unchecked"></i>ACT
                                    </label>                     
                                </div>
                                <div class="checkbox">
                                    <label class="checkbox-custom">
                                        <input type="checkbox" name="required_doc[]" value="19" <?php echo isset($required_doc) && in_array('19', $required_doc_selected) ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-unchecked"></i>A-NET 
                                    </label>                     
                                </div>
                                <div class="checkbox">
                                    <label class="checkbox-custom">
                                        <input type="checkbox" name="required_doc[]" value="20" <?php echo isset($required_doc) && in_array('20', $required_doc_selected) ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-unchecked"></i>GAT
                                    </label>                     
                                </div>
                            </div>
                        </div>
                        <strong>Original score report of English proficiency</strong>
                        <div class="row">
                            <div class="col-lg-6">
                                <div class="checkbox">
                                    <label class="checkbox-custom">
                                        <input type="checkbox" name="required_doc[]" value="21" <?php echo isset($required_doc) && in_array('21', $required_doc_selected) ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-unchecked"></i>TOEFL 
                                    </label>                     
                                </div>
                                <div class="checkbox">
                                    <label class="checkbox-custom">
                                        <input type="checkbox" name="required_doc[]" value="22" <?php echo isset($required_doc) && in_array('22', $required_doc_selected) ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-unchecked"></i>IELTS
                                    </label>                     
                                </div>
                                <div class="checkbox">
                                    <label class="checkbox-custom">
                                        <input type="checkbox" name="required_doc[]" value="23" <?php echo isset($required_doc) && in_array('23', $required_doc_selected) ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-unchecked"></i>SAT 
                                    </label>                     
                                </div>
                            </div>
                            <div class="col-lg-6">
                                <div class="checkbox">
                                    <label class="checkbox-custom">
                                        <input type="checkbox" name="required_doc[]" value="24" <?php echo isset($required_doc) && in_array('24', $required_doc_selected) ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-unchecked"></i>TU-GET
                                    </label>                     
                                </div>
                                <div class="checkbox">
                                    <label class="checkbox-custom">
                                        <input type="checkbox" name="required_doc[]" value="25" <?php echo isset($required_doc) && in_array('25', $required_doc_selected) ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-unchecked"></i>CU-TEP
                                    </label>                     
                                </div>
                                <div class="checkbox">
                                    <label class="checkbox-custom">
                                        <input type="checkbox" name="required_doc[]" value="26" <?php echo isset($required_doc) && in_array('26', $required_doc_selected) ? 'checked="checked"' : ''; ?>>
                                        <i class="icon-unchecked"></i>O-NET 
                                    </label>                     
                                </div>
                            </div>
                        </div>                        
                    </div>
                    <div class="col-lg-1 box-color"  style="height: 355px;">
                        <div class="checkbox center" style="padding-left: 0px;">
                            <label class="checkbox-custom">
                                <input type="checkbox" name="required_doc_staff[]" value="6" <?php echo isset($required_doc_staff) && in_array('6', $required_doc_staff_selected) ? 'checked="checked"' : ''; ?> <?php echo is_loggedin() ? 'disabled="disabled"' : ''; ?>>
                                <i class="icon-unchecked"></i><br/>&nbsp;<br/>&nbsp;<br/>&nbsp;<br/>&nbsp;<br/>&nbsp;<br/>&nbsp;<br/>&nbsp;<br/>&nbsp;<br/>&nbsp;<br/>&nbsp;<br/>&nbsp;
                            </label>                     
                        </div>
                        <div class="checkbox center" style="padding-left: 0px;">
                            <label class="checkbox-custom">
                                <input type="checkbox" name="required_doc_staff[]" value="7" <?php echo isset($required_doc_staff) && in_array('7', $required_doc_staff_selected) ? 'checked="checked"' : ''; ?> <?php echo is_loggedin() ? 'disabled="disabled"' : ''; ?>>
                                <i class="icon-unchecked"></i>
                            </label>                     
                        </div>
                    </div>
                    <div class="col-lg-7">
                        <h4>Application fee 500 Bahts (see INSTRUCTION FOR APPLICATION)</h4>
                        <label>***All photocopies must be certified by the applicant.</label>
                    </div>
                    <div class="col-lg-2">
                        <div class="radio center" style="padding-left: 0px;">
                            <label class="radio-custom">
                                <input type="radio" name="payment_type" value="cash" <?php echo isset($payment_type) && $payment_type == 'cash' ? 'checked="checked"' : ''; ?>>
                                <i class="icon-circle-blank"></i>Cash
                            </label>                     
                        </div>
                    </div>
                    <div class="col-lg-2">
                        <div class="radio center" style="padding-left: 0px;">
                            <label class="radio-custom">
                                <input type="radio" name="payment_type" value="money order" <?php echo isset($payment_type) && $payment_type == 'money order' ? 'checked="checked"' : ''; ?>>
                                <i class="icon-circle-blank"></i>Money order
                            </label>                     
                        </div>
                    </div>
                    <div class="col-lg-1 box-color">
                        <div class="checkbox center" style="padding-left: 0px;">
                            <label class="checkbox-custom">
                                <input type="checkbox" name="required_doc_staff[]" value="8" <?php echo isset($required_doc_staff) && in_array('8', $required_doc_staff_selected) ? 'checked="checked"' : ''; ?> <?php echo is_loggedin() ? 'disabled="disabled"' : ''; ?>>
                                <i class="icon-unchecked"></i><br/>&nbsp;
                            </label>                     
                        </div>
                    </div>
                </div>

                <div class="form-group">
                    <div class="box-info col-lg-8 col-md-offset-2">
                        <strong>Notes:</strong> The Programs do not accept unofficial copies of test results. Only the ORIGINAL score reports are
                        acceptable. The tests must be dated within two years(after January 1, <?php echo date('Y') - 2; ?>.)

                    </div>
                </div>
                <div class="page-header">
                    <h1 id="progress">Part VII.  Declaration and signature</h1>
                </div>
                <h3>I certify that all the information provided by me is true and complete. I understand that deliberately giving fault information will lead to nullification of my admission.</h3>
                <br/><br/>
                <h3 style="text-align: center;">Signature:_________________________________________________ Date: _______/_______ /_______</h3>
                <br/>
                <div class="form-group">
                    <div class="box-info col-lg-10 col-md-offset-1">
                        <div class="row">
                            <div class="col-lg-6">
                                <strong>If you wish to apply in person,<br/>please visit our faculty office at</strong><br/>
                                BSC. International Program Application <br/>
                                Dean Office, 2nd floor, LC 4 Bld. <br/>
                                Faculty of Science and Technology, Thammasat University

                            </div>
                            <div class="col-lg-6" style="border-left: 1px solid black;">
                                <strong>If you wish to apply by mail,<br/>please send your application form to:</strong><br/><br/><br/>
                                <strong>PATHUMTHANI 12121 THAILAND</strong>

                            </div>
                        </div>

                    </div>
                </div>
                <div class="form-group">
                    <div class="col-lg-12 center">
                        <div class="checkbox">
                            <label class="checkbox-custom">
                                <input id="certify_info" type="checkbox">
                                <i class="icon-unchecked"></i>
                                I certify that the above information is true and correct.
                            </label>
                        </div>


                    </div>
                    <div class="col-lg-12 center">                      
                        <a class="btn btn-info" href="#">Cancel</a>
                        <button id="submit_btn" class="btn btn-primary" type="submit" disabled="disabled">Save changes</button>
                    </div>
                </div>
            </form>
        </div>
        <!-- / booking table -->
        <div class="spacing-bottom"></div>
    </section>
</div>
<script type="text/javascript">
    $(function() {
        
        var current_ctd = $("input:radio[name=cdt_rank]:checked").val();
        var current_did = $("input:radio[name=did_rank]:checked").val();
        var current_isc = $("input:radio[name=isc_rank]:checked").val();
        
        function update_rank_value(){
            current_ctd = $("input:radio[name=cdt_rank]:checked").val();
            current_did = $("input:radio[name=did_rank]:checked").val();
            current_isc = $("input:radio[name=isc_rank]:checked").val();
        }
        
        $('.cdt_rank').change(function(){
            var val_selected = $(this).val();
            
            if($("input:radio[name=did_rank]:checked").val()==val_selected){
                $('input:radio[name=did_rank][value='+current_ctd+']').click();                
            }
            
            if($("input:radio[name=isc_rank]:checked").val()==val_selected){
                $('input:radio[name=isc_rank][value='+current_ctd+']').click();
            }
            update_rank_value();
        });
        
        $('.did_rank').change(function(){
            
            var val_selected = $(this).val();
            
            if($("input:radio[name=cdt_rank]:checked").val()==val_selected){
                $('input:radio[name=cdt_rank][value='+current_did+']').click();
            }
            
            if($("input:radio[name=isc_rank]:checked").val()==val_selected){
                $('input:radio[name=isc_rank][value='+current_did+']').click();
            }
            
            update_rank_value();
            
        });
        
        $('.isc_rank').change(function(){
            var val_selected = $(this).val();
            
            if($("input:radio[name=cdt_rank]:checked").val()==val_selected){
                $('input:radio[name=cdt_rank][value='+current_isc+']').click();
            }
            
            if($("input:radio[name=did_rank]:checked").val()==val_selected){
                $('input:radio[name=did_rank][value='+current_isc+']').click();
            }
            
            update_rank_value();
        });
        

        
        
        
        
        
        
        
        
        
        
        
        
        
        $('#citizenship_th,#citizenship_other').change(function() {
            check_citizenship();
        });

        function check_citizenship() {
            if ($('#citizenship_th').is(':checked')) {
                $('#citizenship_of,#passport_no').attr('disabled', 'disabled');
                $('#citizen_id').removeAttr('disabled');

            } else {
                $('#citizenship_of,#passport_no').removeAttr('disabled');
                $('#citizen_id').attr('disabled', 'disabled');
            }
        }

        check_citizenship();

        $('#certify_info').change(function() {
            if ($('#certify_info').is(':checked')) {
                $('#submit_btn').removeAttr('disabled');
            } else {
                $('#submit_btn').attr('disabled', 'disabled');

            }
        });

        $('input').keydown(function(event) {
            if (event.keyCode == 13) {
                event.preventDefault();
                return false;
            }
        });


        $(".check_phone").keydown(function() {
            var input = $(this);
            var phone_befor = input.val();

            setTimeout(function() {

                var patt = /^[0-9-+\s()]+$/;
                result = patt.test(input.val());

                if (!result) {
                    input.val(phone_befor);
                }

            }, 5);
        });

        $("#name_en").keydown(function() {
            var input = $(this);
            var phone_befor = input.val();

            setTimeout(function() {

                var patt = /^[a-zA-z\s]+$/;
                result = patt.test(input.val());

                if (!result) {
                    input.val(phone_befor);
                }

            }, 5);
        });

        $("#name_th").keydown(function() {
            var input = $(this);
            var phone_befor = input.val();

            setTimeout(function() {

                var patt = /^[^a-zA-z0-9]+$/;
                result = patt.test(input.val());

                if (!result) {
                    input.val(phone_befor);
                }

            }, 5);
        });


    });
</script>